Stay at Home: A Covid-19 Message from an E.R Physician, Greg Jacobson, M.D.

Greg Jacobson, MD is a practicing emergency room physician. He's a friend and trusted colleague and he's not prone to overreaction and exaggeration.

We just got off the phone and his message for public health (which also includes YOUR health) is clear and emphatic:

STAY HOME

Greg and medical experts say that a broad societal “lock down” of 12 days duration will stop the spread of the virus. Italy has already taken that action and Greg thinks (or hopes) that we are a few days away from that step in the U.S. — and the sooner the better, he says.

Greg emphasizes that being younger does NOT mean you are without risk. There are people in their 20s to 40s who are currently on ventilators in an ICU because of Covid-19. If you're young, you can get sick and die. At the least, you might be responsible for spreading this virus to another person who might die as a result. This is serious.

Here is Greg's message (from two emails, one sent to KaiNexus employees and one sent to a larger group), shared with his permission (with minor edits). If you have questions, post a comment and I'll get answers and responses from Greg.

Humans,

I awoke this morning (3/15/20) and thought every rational and caring person that I know understood the importance of social distancing. I spent yesterday talking to dozens of people and getting dozens of small social events canceled. I thought my job was done. This morning I spoke to my close friend, a smart and compassionate person, and he was heading with his family to a bike shop and then the Container Store… I realize my job had just begun.

I am an ER doc of 20 years and married to a double-boarded doc with more experience. I realize we have a unique perspective, and therefore, have a duty and obligation to educate and influence as many people as possible. You will never have another day in your life where you can literally make such a small sacrifice and potentially save the lives of dozens and perhaps hundreds or even thousands of people. This is not an exaggeration.

If you care about your fellow humans, I would appeal to you to spend the next hour processing the following information (below email and links to articles) and then send the info to any person you know, especially anyone of influence or power.

I predict we will be on lockdown by Wednesday or Thursday as a country (hopefully earlier) and it will be 3 days too late for hundreds of thousands of people when they are dead in about 1 month. Mayor Adler's 250 person (Austin, TX) ban on 3/14/20 is progressive and an OK start, but it needs to be restricted further ASAP. This needs to happen everywhere. Thousands if not hundreds of thousands of lives will depend on these few days.

I have no memory of ever asking people to forward on information that I send, but I am asking you to forward this and also talk to as many people as you can to tell them to stay home.

Here are more important resources:

Up to date number of cases – look at the exponential curve – this should give you chills – it will be 12 days from complete shutdown before we can influence the curve. Click on the link for the latest updated chart. – https://www.worldometers.info/coronavirus

Below is the updated graph from the US this morning (3/15/20) – this is profound and the most meaningful image we will look at for a very long time. It takes 12 days of total lockdown before you can change the nature of that curve. We are in for a world of hurt as a society if we don't flatten that curve. Italy is 12 days ahead of us. They are on day 6-7 of lockdown. They have another 7-8 days of exponential growth. Take a look at their curve it is still going straight up exponentially. They have been out of ICU beds for days.

Mark's note: Keep in mind that the chart should probably read “Confirmed Cases” since many people who have the virus certainly haven't had that confirmed by a test yet.

Please be a part of the solution and influence others to be the solution as well.

Stay physically distant,

Greg

His previous email:

KaiNexians,

I wanted to follow up on the last 24 hours. Last night the gravity of what our country and world are about to go through hit me like a truck. Flattening the curve is about saving the lives, not of a handful of people, but potentially hundreds of thousands, maybe millions, worldwide. If our current healthcare system gets hit with a bunch of people coming all at once, there will be hard decisions that doctors and ethicists will be making in the next 3-4 weeks. Decisions about who will live and who will die. There are only so many ventilators and ICU beds. The old and infirm will die because we could not give them the care they needed and many will get maximum care and still die.

I drove back from San Antonio today and told my parents that I would not see them again until this dies down. They are both over 70 and [my wife] Adrienne and I have a responsibility to go to our ER shifts where we will be inevitably exposed. When I drove down South Congress, I saw normal activity, normal shopping, and outdoor bar areas packed. It was mind-boggling. There are not just 2,500 US cases of Covid-19 currently. That is the confirmed number of cases in a country that has limited testing ability at the moment. There are likely hundreds of thousands.

Today, all those people not isolating potentially doubled the number of cases.

We made the decision on Wednesday night to become a remote company during this crisis in order to help limit the spread of the virus. Making the decision to become a remote company, but then going to the grocery store, restaurants, home depot, and coffee shops defeats the purpose of us being a remote company. It also makes us hypocrites if we say we are being socially responsible.

I do not believe many of us will know many people younger than 50 that die from this disease. We will all know people older than 70. Social isolation/distancing is not about us. It is about them. Please stay at home. Only go out if it's necessary. Think in terms of “Is it worth someone dying that I go do _____?” If you do go out, wear a mask. Go when there are few people out and vigorously wipe everything down that you bring into the house with sanitizer wipes. Use hand sanitizer liberally.

Note: Spanish and French governments just locked everything down. The US will be doing this in the next couple of days. All indications are that the US will have been a couple of days too late.

When we started talking about this two weeks ago, I thought this was going to be a very, very, very bad flu season. Yesterday, I was concerned and communicated about flattening the curve. Now seeing the beginning of the curve, I am processing this all and I am petrified. Please stay home. I understand that 98% of the population doesn't “get it” as illustrated by the masses of people on South Congress. Today I have managed to stop three couples going out to dinner tonight, a family of 7 going camping tomorrow, my own daughter's birthday party from happening tonight, and a classmate of Micah's birthday party tomorrow. How many social events can you stop before you go to bed?

Many of you have known me for a long time. I am not prone to hyperbole. “Overreacting” now is the best thing we can do to lessen the disaster that is coming. This is what the first days of a pandemic feel like… like there is nothing going on.

"I would like to see a dramatic diminution of the personal interaction we see in restaurants and in bars," Dr. Fauci says about the coronavirus. Young people are not immune: "There are going to be people who are young who are going to wind up getting seriously ill" #CNNSOTUpic.twitter.com/iF5J2gccta

It’s no secret that the world is preoccupied with COVID-19, and precautions to slow the spread of this virus are being taken everywhere we turn. After a great deal of reading, prayer, and discussions with people well versed in infectious diseases, I have decided to close the [company] office for the next week and possibly longer. The health of our team, our clients, and the families of all must take precedence during this global pandemic.

Besides the health of our team and clients, I am in large part making this decision so that [we are] doing its part to “flatten the curve” for COVID-19. Our nation’s hospitals and doctors can easily provide top care to our entire nation, so long as the people that get infected do so over a long period, rather than the rapid spread that other countries like Italy have seen.

A great example of this that helped solidify my decision is the comparison between St. Louis and Philadelphia during the 1918 Spanish Flu epidemic. During this epidemic, St. Louis acted fast, enforcing social distancing and the shutdown of all offices and churches that weren’t vital to the public, a decision that some considered overly cautious. Meanwhile, Philadelphia decided to continue business as usual. The infection spread so quickly in Philadelphia that hospitals and doctors were pushed beyond their capacity in the two weeks that it took them to follow St. Louis’s lead, resulting in more than twice the percentage of deaths as was seen in St. Louis.

It is my hope that by being “overly cautious” like St. Louis, we can do our part to help our country, state, and nation get through this very trying experience. We really have no idea how many infected people there are in the country, each state, and in our local region. That will likely improve over the next week or two, and we will be able to make more educated decisions about office closures when that data is available. I am hopeful that, in the next week or two, we will be able to look back at my decision to close the office and agree that it was, in fact, overly cautious. However, I could not accept the opposite happening.

Thanks Mark, this is an important message that needs to be emphasized and reemphasized. We are a global, national and local society. We need to be considerate of how our actions impact others (and how our actions impact ourselves).

Too many American families rely on hourly wages to put food on their tables, pay their rents and keep their utilities running. For these families, staying at home is not a viable option since most of them do not get paid time off. Having kids out of school further aggravates the situation as these families also do not have money for babysitters or daycare. What will big corporations do to help these families survive? Will the government offer a debt moratorium? What will banks and credit card companies do to help families in hardship? I’m all for precautionary measures and agree entirely with the science and statistics, but how can low-income families survive under these circumstances?

These are unprecedented times… I hope there are financial solutions from companies and the government to make sure that everybody can survive in the short term so we can make things better beyond the short term.

President Trump’s announced restricting gatherings of greater than 10 people just now. I hope this will mark the turning point in convincing the masses to take this seriously, but there is still a lot of convincing left to be done! Being physically distant is hard! I almost messed up today as I had an annual A/C maintenance appointment scheduled weeks ago and he almost showed up today.

Anyway, below is today’s post continuing to explain the importance of physical distancing. My prediction is holding currently and hopefully we will be in a nationally forced lock down soon. By lockdown, I believe we will be able to get food and other essentials, but the governement will focus on restricting how much human contact we have. Think about it, if the government completely prevents anyone from leaving their house, we will have a much bigger problem on our hands (there are 393 million guns out there!). So this will be focused on limiting not eliminating.

To me this change of tide is helping me sleep better, but now we need to prepare for the onslought of patients. I saw a model that predicts it will occur on week 5, and there will either be no shortages or there will be thousand and thousands of ICU shortages. So, I think it is too early to focus on the specific numbers. Hopefully, the leaders in our healthcare system are planning for this.

So, I want to focus on what we CAN do… yes, thats right you guessed it. Stay home! Whatever the ultimate outcome, we can make it better by staying physically distant. If our ICU’s don’t have a shortage during this crisis, it will be because of what we do today. If you don’t believe this, then you either don’t understand the word exponential or you don’t believe in math. If you don’t believe in math, I can’t help you. But, if you don’t understand the word exponential, I can help… I wrote an awesome blog post! I put the text in this email below so you don’t even have to click but if you want to read it on the blog here is the link.

I decided to focus today’s post on understanding what the word exponential means because some people asked me in confidence to explain the word. It’s been thrown around a lot and if you really don’t understand the word, you won’t understand the importance of being physically distant. To pique your interest, let me ask you one question. Would you rather have $2.6m or $5.3m dollars (especially if I told you you could make that in one day). If that piques your interest, read the post.

Please, please, please pass this information on to everyone you can think of! We have more work to do.

I just received word form the Heatlh Department that I am positive for COVID 19. Looks like my role as a physician in this battle is over for a while. I have mild symptoms and hope they stay that way. I am angry with the way this pandemic has been handled. We have no PPE and no testing supplies. I feel betrayed.